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Y5 O+G > Contraception > Flashcards

Contraception Flashcards

1
Q

What is important to ascertain when considering contraception

A

What kind do they need: barrier, long-term, emergency
Is the purpose to prevent pregnancy or STIs
Are they happy to regularly take a pill / will they be able to remember
PMH Migraine with aura
FHx oestrogen-dependant cancers (endometrial, breast, ovarian)

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2
Q

What are the types of barrier contraception and what are their advantages and disadvantages

A

Condom: (-) least effective contraception
Female condom: (-) has to be held in positions
Cervical diaphragm: (+) has spermicidal gel (-) requires planning for insertion and after intercourse (±2 hours)
Caya (diaphragm): popular in post natal women

Only form of contraception to also protect against STIs

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3
Q

What are the types of long acting reversible contraception (LARC)

A

Copper IUD
Hormone coil (IUS)
Implant
Depot
Jaydess
Kyleena

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4
Q

How does the copper coil work and what are the contraindications

A

Aseptic inflammation → decreases sperm motility, survival, and ability to implant
Contraindications to IUDs/IUS = pregnancy, PID, malignancy, unknown bleeding

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5
Q

How and when is the copper coil administered

A

Inserted:
- Coil on stem only: 5 years
- Coil on stem + T arms: 10 years
Immediate contraceptive ability, inserted at any point in cycle
After childbirth, insert: <48 hours OR after 4 weeks

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6
Q

What are the disadvantages of the copper coil

A

Longer, more painful periods:
Heavier periods (not recommended for menorrhagia)
Dysmenorrhoea
Uterine perforation (2 per 1000 insertion)
Pelvic inflammatory disease (first 20 days)
1 in 20 risk of expulsion (first 3 months)

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7
Q

How does the hormone coil work

A

Releases progesterone → thins the lining of the endometrium → induces lighter periods or even amenorrhoea
- Beneficial to anaemic patients and those with uterine bleeding concerns e.g. fibroids
- Prevents un-opposed oestrogen and therefore endometrial hyperplasia
- Beneficial for STI prevention due to cervical mucous thickening → mucous plug

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8
Q

How and when is the hormone coil inserted and what are the contraindications

A

Inserted and left for 3-5 years
Additional contraception is needed for 7 days after insertion (unless <5 days of a new cycle)
CI: pregnancy, PID, malignancy, unknown bleeding (must do STI screen prior)

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9
Q

What are the disadvantages of the hormone coil

A

Irregular bleeding (but followed by lighter menses/amenorrhoea)
Acne
Constipation
Irritability
Breast tenderness
Mood changes
Headache
Coil expulsion
Infection
Perforation

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10
Q

What is Jaydess and Kyleena

A

Jaydess = mirena-like alternative but effective for only 3 years, thinner, easier insertion, preferable in nulliparous women
Kyleena = Smaller IUS, effective for 5 years, associated with weight gain

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11
Q

What is the MOA for the implant

A

Releases progesterone (etonogestrel)
Prevents ovulation and thickens the cervical mucous

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12
Q

How and when is the implant administered

A

Small rod inserted sub-dermally into non-dominant arm with local anaesthetic
Lasts for 3 years
Additional contraception is needed for 7 days after insertion (unless <5 days of a new cycle)

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13
Q

What are the disadvantages of the implant

A

GI: constipation
Irregular bleeding
irritability and mood changes
Breast tenderness
Headache
Implant site infection
Acne

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14
Q

How does Depo-provera work

A

Progesterone (medroxyprogesterone acetate)
Prevents ovulation, thickens cervical mucous

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15
Q

How and when is depo-provera administered

A

IM
Lasts 12-14 weeks (4 months)
Needs at least 7 days to be effective - use barrier in this time

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16
Q

What are the disadvantages of depo-provera

A

Weight gain
Ectopic pregnancy
Takes 6-12 months for fertility to return from last injection
Osteoporosis (should be avoided in extreme reproductive age e.g. 13, teens, women in their 40s)

GI: constipation
Irregular bleeding
irritability and mood changes
Breast tenderness
Headache
Acne

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17
Q

What are the types of user-dependent contraception

A

Combined oral contraceptive pill/patch/vaginal ring
Progesterone only pill

18
Q

What is the MOA for the COCP

A

Oestrogen (ethinyl oestradiol) and progesterone (progestin) that prevents ovulation

19
Q

How and when should combined oral contraception be taken

A

Day 1 (up to day 5) of the menstrual cycle is the preferred day to start (immediate protection from pregnancy)
- If there is a need for extra barrier contraception, this should be used for at least 7 days

Forms:
Pills (e.g. microgynon): 1 pill daily for 3 weeks followed by a week of no pill for withdrawal bleed OR 1 pill daily for 9 weeks followed by 1 week off
Patches: 1 patch a week for 3 weeks followed by no patch for a week for withdrawal bleed
Vaginal ring: 1 ring for 3 weeks, then take out for one week)

20
Q

What are the benefits of using the COCP

A

> 99% effective
Reversible on stopping
Less pain, more regular, lighter periods
Reduced risk of ovarian, endometrial, bowel cancer

21
Q

What are the disadvantages of the COCP

A

Easy to forget to take
Does not protect against STIs
Increased risk of VTE (stoke, heart disease)
Increased risk of breast and cervical cancer
Side effects: headache, N&V, breast tenderness

22
Q

What are the contraindications for the COCP

A

UKMEC 4:
Migraine with aura
<6w postpartum and breastfeeding
Ischaemic of valvular HD
Diabetes with complications
>35yo, smoke >15/day
PMHx VTE, TIA, stroke
Severe cirrhosis or liver tumour
BP >160/100
Current breast cancer

23
Q

What are the considerations for the COCP around surgery

A

Needs to be discontinued at least 4 weeks prior to surgery
Re-start 2 weeks after full mobilisation

24
Q

What should be done if the patient misses a dose of the COCP

A

1 pill missed: take last pill and current pill (even if 2 in 1 day) → no further action needed
2 pills missed: take last pill and current pill (even if 2 in 1 day) AND:
- Use condoms until pill has been taken correctly for 7 days in a row
- 2 Missed in Week 1: consider emergency contraception
- 2 Missed in Week 2: no need for emergency contraception o
- Missed in Week 3: finish current pack, start new pack immediately (no pill-free break)

25
Q

What is the MOA for the progesterone only pill

A

Progesterone (progestin): levonorgestrel, norethisterone, desogestrel (cerazette)
Thickens the cervical mucous (desogestrel stops ovulation)

26
Q

How and when should the progesterone only pill be taken

A

OD at the same time every day (no pill-free week)
If started on the first 5 days of the cycle (28-day cycle) → confers immediate contraceptive protection
If starting at any other time, use additional measures for the first 2 days
If switching over from the COCP, it provides immediate protection

27
Q

What are the disadvantages of the progesterone only pill

A

Easy to forget to take
Initial irregular bleeding → continued, regular bleeding, amenorrhoea
Osteoporosis and ovarian cyst
SEs: irregular bleeding, acne, constipation, irritability, breast tenderness, mood changes, headache

28
Q

What should be done if a patient misses their dose of progesterone only pill

A

Traditional (micronor, noriday, nogeston, femulen)
- <3hours: continue as normal
- >3 hours: take the missed pill ASAP and continue with the pack, use condoms until pill taking has been re-established for 48 hours

Cerazette (desogestrel)
- <12h: continue as normal
- >12h: take missed pill ASAP, continue with rest of pack, condoms until re-establishment for 48h

29
Q

What should be done if a patient forgets to change their combine hormonal transdermal patch

A

Delayed change <48 hours: change immediately with no further precautions

Delayed change >48 hours (week 1 or 2): change immediately, use barrier protection for 7 days
- If UPSI <5 days or during extended patch-free period, consider emergency contraception

Delayed removal >48 hours (week 3): remove immediately and apply next patch on the usual start date of the next cycle (no additional contraception is needed)

Delayed at the end of the patch-free week: use barrier contraception for 7 day

30
Q

Where may someone acquire emergency contraception

A

Pharmacies, sexual health clinics, GP centres, A&E, some schools
£24.99, but free for under 16s

31
Q

What are the options for emergency contraception

A

Levonorgesterol (Levonelle)
Copper coil (IUD)
Ulipristal acetate (ellaOne)

32
Q

What is the MOA for Levonorgesterol (Levonelle) and when is it effective

A

High dose progesterone - stops ovulation and inhibits implantation
taken within 3 days (72h) of UPSI
95% effective in <24 hours
84% effective <72 hours

33
Q

What is the MOA for Ulipristal acetate (ellaOne)

A

Selective progesterone receptor modulator → inhibits ovulation
Use within 5 days
95% effective in <120 hours (5 days)
First line if BMI >26

34
Q

What is the MOA of the copper IUD as emergency contraception

A

Most effective form of contraception
Spermicidal and inhibits implantation
>99% effective in <120 hours
Use within 5 days of UPSI

35
Q

What is the Pearl index

A

describes the chance of becoming pregnant on contraception
Pearl index = the number of pregnancies occurring per 100 woman-years

36
Q

When can women stop using barrier contraception for UPSI

A

<50: after 2 years of amenorrhoea
>50: after 1 year of amenorrhoea

37
Q

When can women stop using the COCP for UPSI

A

Continue and stop after 50yo, switch to a non-hormonal or the POP

38
Q

When can women stop using progesterone contraceptive forms for UPSI

A

Can continue beyond 50 years
Depo-provera: stop at 50yo and switch to a non-hormonal/POP

39
Q

What should be done if a patient vomits after taking emergency contraception

A

if vomiting occurs within 3 hours then the dose should be repeated

40
Q

When can hormonal contraception be started after taking emergency contraception

A

levornogestrel (Levonelle): immediately
Ulipristal(EllaOne): Contraception with the pill, patch or ring should be started, or restarted, 5 days after. Barrier methods should be used during this period

41
Q
A

Y5 O+G (70 decks)

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